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Am J Perinatol
DOI: 10.1055/a-2405-1381
Review Article

Daily vs Alternate Day Iron Supplementation for Pregnant Women With Iron Deficiency Anemia: A Randomized Controlled Trial.

Melissa Chu Lam 
1   Maternal Fetal Medicine, Mount Sinai West, New York, United States
,
Binny Khandakar Khandakar
2   Pathology, Mount Sinai West, New York, United States
,
Isaak Heon
2   Pathology, Mount Sinai West, New York, United States
,
Farrah Hussain
1   Maternal Fetal Medicine, Mount Sinai West, New York, United States
,
Kristina Martimucci
1   Maternal Fetal Medicine, Mount Sinai West, New York, United States
,
Elianna Kaplowitz 
3   Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, United States (Ringgold ID: RIN5925)
,
Jessica Overbey
4   Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, United States (Ringgold ID: RIN5925)
,
Lois Brustman
5   Maternal Fetal Medicine, Obstetrics and Gynecology, Mount Sinai West, New York, United States
,
Barak Rosenn
6   Maternal Fetal Medicine, Jersey City Medical Center, New Jersey, United States
› Author Affiliations Clinical Trial: Registration number (trial ID): NCT03562143, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Randomized
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Objective: Evaluate the most effective regimen to raise hemoglobin by comparing alternate day dosing of iron to daily dosing in pregnant women with iron deficiency anemia. Study Design: Women with Hb <11.0 g/dl and ferritin  25 ug/L between 12w0d-34w0d gestation were recruited. 88 patients were randomized using block randomization with 1:1 allocation to receive either 1 tablet of 325mg ferrous sulfate on consecutive days or 2 tablets every other day. The primary outcome, the change in hemoglobin after 6 weeks of treatment was assessed using an analysis of covariance to adjust for baseline level. Secondary outcomes included change in ferritin, hepcidin, side effects, and compliance. Patients completed a questionnaire to assess for adverse symptoms and adherence was monitored by installing a pill reminder app on smartphones of patients. Results: 88 patients were consented. The daily iron group had a greater proportion of nulliparous women (40% vs 7%). Most patients (98%) had mild anemia (Hb 9-10.9 g/dl) at recruitment, with a median gestational age of 28.1 weeks (IQR: 25.6,30.9) and median duration of treatment of 42 days (IQR: 35,45). At 6 weeks, the daily iron group had a mean increase in Hb of 0.8±0.9 g/dL, while the alternate day iron group had a mean increase of 0.5±1.0 g/dL (baseline adjusted difference of means: -0.3 (95% CI: -0.7,0.1), p =0.15). Frequency of adverse effects attributable to iron were similar between groups. Patient self-reported compliance to treatment was also similar between groups. Among those that used the app, compliance was higher among the daily group compared to the alternate daily group (median 95.5% (IQR 75,100) vs 85% (IQR 40, 92)), though this difference was not statistically significant (p=0.07). Conclusions: This trial suggests that there are no significant differences between alternate day iron supplementation and daily iron supplementation for treating iron deficiency anemia.



Publication History

Received: 09 January 2024

Accepted after revision: 25 August 2024

Accepted Manuscript online:
29 August 2024

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